Abstract

Background

The COVID-19 pandemic resulted in unprecedented emphasis on infection control procedures; however, it is unknown whether the pandemic altered the prevalence of C. difficile infection (CDI). This study aimed to investigate CDI prevalence before and during the COVID-19 pandemic in a national sample of United States (U.S.) hospitals.

Methods

This was a retrospective cohort study using the Premier Healthcare Database. Patients with laboratory-confirmed CDI (i.e., positive C. difficile stool test) from April 2019 to March 2020 (pre-COVID period) and April 2020 to March 2021 (COVID period) were included. CDI prevalence (CDI encounters per 10,000 total encounters) and inpatient outcomes (e.g., mortality, hospital length of stay) were compared between pre-COVID and COVID periods using bivariable statistical analyses or interrupted time series analysis.

Results

A total of 25,992 CDI encounters were included representing 22,130 unique CDI patients. Overall, CDI prevalence decreased from the pre-COVID to COVID period (12.2 CDI encounters per 10,000 total encounters vs. 8.9 per 10,000, p < 0.0001), driven primarily by a reduction in inpatient CDI prevalence (57.8 per 10,000 vs. 49.4 per 10,000, p < 0.0001); however, the rate ratio did not significantly change over time (RR 1.04, 95% CI 0.90-1.20). From the pre-COVID to COVID period, CDI patients experience higher inpatient mortality (7.4% vs. 5.5% p < 0.0001) and higher median encounter cost ($12,862 vs. 10,834, p < 0.0001).

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